Individual
DR. ALTUS HARVEY LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
202 MEADOWLANE ST, EUPORA, MS 39744-2219
(662) 258-2461
(662) 258-2408
Mailing address
328 S MAIN ST, GRENADA, MS 38901-3215
(662) 801-6161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2185-85
MS
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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